Improving impaired attention may help patients recover from stroke

Jul 23, 2009

It may be possible to improve impaired attention after stroke -- which could aid recovery -- according to research reported in Stroke: Journal of the American Heart Association.

Impaired attention is the most prominent stroke-related neuropsychological change and is reported in at least 46 percent and as many as 92 percent of stroke survivors, said Suzanne L. Barker-Collo, Ph.D., a senior lecturer and neuropsychologist at the University of Auckland in New Zealand.

Impaired attention can reduce cognitive productivity and the ability to focus on tasks. It's key to re-learning motor skills.

In the first full-scale single-blinded, randomized clinical trial using Attention Process Training (APT), 78 stroke survivors were randomized to receive APT or standard rehabilitation care. APT is designed to improve the ability to maintain attention, as well as to shift attention (such as when having a conversation with more than one person) and to attend to more than one thing at a time. It's been used successfully in people after traumatic brain injuries but hasn't been tested in stroke patients.

Researchers tested participants in four aspects of attention — sustained, selective, divided and alternating — as well as visual and auditory aspects of attention. Patients receiving APT had up to 30 hours of individual training, in one-hour sessions for four weeks. They received on average 14 hours of training.

Researchers said people who underwent APT had a significantly greater improvement on a test of attention than those who received standard care. At six months, those who had APT had an average improvement of 2.49 standard deviations higher than standard care patients on "full-scale attention scores."

The improvement in attention didn't correlate with significant improvements in outcomes, but researchers said six months may not be enough time to gauge the impact of improved attention.

Differences on other measures of attention and broader outcomes were not significant.

Early identification and rehabilitation of attention should be part of stroke rehabilitation because APT is a viable and effective way to improve attention deficits after stroke, said the researchers, who recommend more research on the issue.

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